Preoperative Preparation

The preoperative preparation encompasses the general preparation of a patient for any major abdominal surgery, and, additionally, the optimization of specific metabolic and endocrine abnormalities imposed by the pathology.

Informed consent should warn the patient of the risks of conversion to open surgery, adjacent organ injury, hemorrhage, and blood transfusion. Blood should be cross-matched, and the patient fasted for six hours prior to surgery. The operative side should be confirmed with the patient prior to admission to the operating theatre and marked on the patient's abdomen away from the operative site to avoid tattooing the skin. All imaging should be placed on the viewing screens in the operating theatre and reviewed prior to the commencement of surgery. Antithromboembolism stockings and pneumatic compression devices should be applied and subcutaneous heparin administered on induction as part of deep venous thrombosis prophylaxis. Antibiotic prophylaxis with an intravenous cephalosporin should be administered on induction. Bowel preparation is not routinely administered, because the incidence of bowel injury is extremely low.

Specific electrolyte and metabolic abnormalities are corrected in close liaison with an endocrinologist. Patients with aldosteronomas may have hypokalemia requiring correction with potassium supplements or potassium-sparing diuretics. Pheochromocytomas require preoperative blood pressure control, initially with alpha-adrenergic blockade, followed by beta-adrenergic blockade if reflex tachycardia occurs. An arterial line and central venous cannula are placed for intraoperative monitoring.

Early access to the adrenal vein prior to manipulation of the adrenal gland or periadrenal tissue is the main advantage of the lateral transperitoneal route.

Mobilization of the colon is rarely required on the right side; however, mobilization of the splenic flexure and descending colon are required to gain access to the left adrenal vein.

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